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Cloud Health Services, Part 1: Benefits and Complications

By Richard Adhikari
May 22, 2018 5:00 AM PT
the cloud offers promise for many healthcare-related services but standardization is a problem

The cloud offers a host of potential uses, according to the healthcare industry and academic medical center representatives who participated in a Healthcare Information and Management Systems Society survey last year.

Application hosting was the top use, identified by 90 percent of the 64 respondents.

Other potential uses cited:

  • Disaster recovery and backup - 84 percent
  • Hosting primary data storage such as application data - 74 percent
  • Hosted email services - nearly 70 percent
  • Managed services - 52 percent
  • Virtual servers - 36.5 percent
  • Security - 36.5 percent

The global healthcare cloud computing market will reach US$35 billion in 2022, from about $20 billion in 2017, according to BCC Research.

Cloud computing lets user organizations avoid heavy capital expenditures, and it requires less skilled IT staff, according to a report from the Cloud Standards Customer Council, an end-user advocacy group dedicated to accelerating cloud adoption.

The cloud also offers the following potential advantages:

  • Easier scalability and ability to adjust rapidly to demand;
  • Better security and privacy for health data and health systems than in-house systems;
  • Improved information sharing through standard protocols -- although vendor contracts and technical impediments remain a problem;
  • Support for rapid development and innovation, especially for mobile technologies and the IoT; and
  • Better analytics capabilities, through services such as intelligent business process management suites and case management frameworks to mitigate medical mistakes.

"Cloud services in healthcare is a rapidly evolving area, and a case where cloud makes a lot of sense from a cost management and portability perspective," Rebecca Wettemann, VP of research at Nucleus Research, told the E-Commerce Times.

However, all is not rosy in cloud healthcare land. Standardization has been a problem, so information sharing is not quite as easy as it should be. Security also has been problematic.

Everyone Wants to Get Into the Act

Major cloud players Google, Microsoft and Amazon have been pushing into the healthcare field, along with several smaller firms. Facebook and Apple also have been showing interest.

"We're seeing a great deal of interest in the cloud in the healthcare industry," remarked Joe Corkery, Google Cloud's head of product healthcare and life sciences.

Most have been offering traditional cloud-based services such as hosting and Software as a Service, as well as security, data storage and data crunching. Google and Apple have been leveraging the Internet of Things through mobile devices.

All providers have an eye on the IoT, which is expected to generate a huge market, sparked by smart cars, homes, cities and the ubiquity of mobile devices.

"Offerings that are more enterprise-focused -- like Microsoft Azure, IBM SoftLayer and Dell Virtustream -- should have a significant advantage because of their higher focus on security," observed Rob Enderle, principal analyst at the Enderle Group.

On the other hand, smaller companies "should have a significant advantage, thanks to the strong privacy laws, if they have that extra focus on security," he told the E-Commerce Times, and don't have "a bad reputation for the cloud, like Apple, or a bad reputation for privacy, like Google."

The Healthcare Tower of Babel

Interoperability is a real issue in the healthcare industry. Some blame the problem on legislation -- specifically, the 2009 Health Information Technology for Economic and Clinical Health.

The HITECH Act was designed to promote the adoption and use of electronic health records, but the legislation's overall design pushed interoperability in a limited way, according to Julia Adler-Milstein, an associate professor at the University of Michigan's School of Public Health.

The U.S. Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT put off defining criteria for the Health Information Exchange until the second stage, Adler-Milstein pointed out.

Further, interoperability is not just a technological issue, she noted. There are also governance and trust issues, business agreements and confidentiality issues.

"Multiple standards, as well as flavors of those standards for medical and health data, have been developed over time ... based on the changing needs of the technology products being developed," Google's Corkery told the E-Commerce Times.

The Office of the U.S. National Coordinator for Health IT earlier this year released its 2018 Interoperability Standards Advisory.

However, the advisory is for informational purposes only. It is non-binding and does not create or confer any rights or obligations for or on any person or entity.

International standards organizations have stepped in to take up the slack. Health Level 7 International "has taken an active role in the development of standards," Corkery noted.

HL7v2 is "the dominant data exchange format used in clinical settings today," he added.

Fast Healthcare Interoperability Resources -- managed by the nonprofit FHIR Foundation, which is closely affiliated with HL7 -- is an emergent standard, said Corkery.

At the industry level, the Google Healthcare application programming interface is an attempt to get around the interoperability problem.

The API provides "a cloud-based implementation of several widely deployed standards -- HL7v2, FHIR and DICOM -- to ingest, store, query and analyze data using protocols and formats that clinical systems use today," Corkery said. "The intent ... is not to replace existing standards, but to deliver interoperability between clinical systems and Google cloud services."

Cloud Health Services, Part 2: Privacy and Security


Richard Adhikari has been an ECT News Network reporter since 2008. His areas of focus include cybersecurity, mobile technologies, CRM, databases, software development, mainframe and mid-range computing, and application development. He has written and edited for numerous publications, including Information Week and Computerworld. He is the author of two books on client/server technology. Email Richard.


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